MYCETOMA

 This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.


This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

CHIEF COMPLAINTS
A 60 year old Male, mechanic by occupation, resident of nakrekal came with chief complaints of
• Multiple Painless oozing leisions over left foot since 3 days and right foot since 15 days
• Granules discharging from leisions intermittently


HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic 2 yrs back and then he developed multiple leisions on right foot .
The leisions are sudden in onset ,non progressive,  painless, discharging granules intermittently (on and off course) and no itching .
They were treated with topical drugs and resolved within 1 week.
Patient now complains of similar leisions on right foot since 15 days and on left foot since 3 days.
There was no history of trauma.


PAST HISTORY
No similar complaints in the past
Not a known case of Hypertension, Diabetes, Asthma, Epilepsy, Tuberculosis.
History of retroviral disease since 15 years and is on medication.

FAMILY HISTORY
No significant family history

PERSONAL HISTORY
Diet : mixed
Appetite : normal
Bowel and bladder movements:  regular
Sleep: adequate
Addictions: none

GENERAL EXAMINATION
Patient is conscious, coherent and cooperative
Well oriented to time ,place and person
Moderately built and moderately nourished
No pallor
No icterus
No cyanosis
No clubbing
No lymphadenopathy
Pedal edema present
Height 160cm
Weight 68kgs

VITALS
BP on admission: 200/110 mmhg
GRBS : 102 

BP: 124/ 80mm Hg
PR: 80bpm
Temperature : 96 F
RR: 16cpm

SYSTEMIC EXAMINATION
RS: Trachea central
       NVBS heard
CVS: S1 S2 heard , no murmurs
CNS : NFD
PA: Soft, non tender ,no organomegaly

LOCAL EXAMINATION
Multiple ulcers with discharging sinuses are present over dorsal aspect of foot.

INVESTIGATIONS











PROVISIONAL DIAGNOSIS
Mycetoma ?
Stasis eczema?
Cellulitis ?

TREATMENT 
Tab PCM 650mg TID
Nicardia 40mg stat
Amlong 5mg stat

TREATMENT AT DIACHARGE
Tab Amoxiclav 625mg TID for 5 days
Pantop 40mg OD for 5 days
Amlong 5mg OD for 3 days

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